“We highlight the importance of fostering R&D, in particular for priority pathogens as identified by WHO and tuberculosis.” G20 Leaders Declaration, Shaping an interconnected world, Hamburg, July 7-8, 2017

In the 15-page declaration G20 leaders produced agreeing to actions toward “building resilience, improving sustainability, and assuming responsibility,” in “an interconnected world,” amidst a brief section devoted to health systems, security and antimicrobial resistance, the one mention of tuberculosis could seem negligible, but to TB response advocates worldwide, it signals encouragement, cause of celebration, and “groundbreaking achievement.”

It is the first mention ever in a declaration from the leaders of the world’s largest economies of a illness that has been declared the world’s No. 1 infectious disease killer. It is a small, but meaningful step, advocates said, in a global response to the toll of drug-resistant tuberculosis, that to this point has been “far from adequate,” as Stop TB Director Lucica Ditiu put it, and an opening to the next step, which is working to ensure that action follows.

It comes several months after the WHO release of list of “priority pathogens” resistant to existing treatments, for which urgent needs for new antimicrobials had been identified, that did not include tuberculosis, the disease responsible for a third of all drug-resistance deaths. And it comes as two reports highlight failures around the world to respond to the spread of drug-resistant tuberculosis with the adoption of proven policies and sufficient funding to put them into practice.

Out of Step, a survey of policy and practice adhering to WHO guidelines for TB diagnosis and TB as well as HIV treatment in 29 countries, released July 5th, shows adoption and implementation of recommended policies in as few as half to a third of countries most heavily affected by the disease. Complementing that, Protecting the United States from the Health Security Risk of Global Tuberculosis, from the Center for Strategic and International Studies Global Health Policy Center, highlights global gaps accelerating the spread of tuberculosis, including drug-resistant tuberculosis, domestically and worldwide, noting “It is more cost-effective for the U.S. Government to invest in preventing the development and spread of drug-resistant TB epidemics globally than to respond to an epidemic in the United States.

The cost of controlling a 1990s outbreak of multidrug-resistant tuberculosis in New York alone, the CSIS report notes, added up to at least $1 billion. But the report also notes the Trump administration budget plan for the coming fiscal year proposes cuts to every avenue of investment in combating the disease — from research and development, to training, to health system strengthening, to direct responses to diagnose, treat, cure, and prevent the disease — through the U.S. Centers for Disease Control and Prevention, through USAID, through the President’s Emergency Plan for AIDS Relief, and through the National Institutes of Health. That proposal rests in the hands of Congressional appropriators who are expected to prepare their responses to the proposal this week. The report urges the appropriation of $450 million for bilateral global TB control efforts.